FORM 1023-EZ for ROCKSTAR KUSTOM HEARTZ

Field Data
EIN 81-3876623
Case Number EO-2016358-000263
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name ROCKSTAR KUSTOM HEARTZ
Organization’s Mailing Address 2536 RIMROCK AVE STE 400-333
City GRAND JUNCTION
State CO
ZIP 81505-8669
Accounting period End 12
Primary contact name THAD SHUPE
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

THAD SHUPE
DIRECTOR
2536 RIMROCK AVE SUITE 400-333
GRAND JUNCTION CO 81505-8669

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/14/2014
Organization Incorporation State CO
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E86 - Patient Services - Entertainment, Recreation
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds Yes
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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